EXAM #2: SURGICAL COMPLICATIONS IN DM Flashcards Preview

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Flashcards in EXAM #2: SURGICAL COMPLICATIONS IN DM Deck (19):
1

How does inflammation influence DM?

Inflammation exacerbates DM

2

How does the PreOp eval for elective surgery differ from the emergent eval?

Elective= time to get chronic conditions under control

3

In a DM patient what do you want to review in terms of cardiac history?

1) Stents
2) Echo
3) Functional status i.e. "can you walk around the block?"

4

In terms of anesthesiology, what do you need to be concerned about with a DM patient?

Neuropathy--esp. in terms of local/regional anesthesia

5

What are the elements of a PreOp Eval that should be done on the emergent patient?

1) Establish baseline
2) EKG
3) Blood work
4) Optimize the things that you can

6

Why are wound infections rampant in DM patients?

1) Reduced capillary perfusion
2) Reduced oxygen and nutrient delivery
3) Impaired circulation of antimicrobials
4) Hyperglycemia

7

What are the post-op blood glucose goals for s/p CABG patients?

Blood glucose less than or equal to 180 mg/dL

8

What did the NICE-SUGAR study find?

Intensive post-op insulin therapy INCREASED mortality

*Goal now is to be below 180-200 mg/dL

9

What is a major adverse effect associated with Metformin?

Lactic acidosis

10

What is the recommendation for oral glucose lowering agents?

Stop oral glucose medications

11

What is the glucose threshold for an insulin drip for a DM patient in the hospital?

300 mg/dL

12

What should you remember about combining insulin modalities?

Do not combine i.e. don't do drip AND subQ

13

What is gastroparesis?

Delayed gastric emptying

14

When is DM gastroparesis concerning?

Intubation--full stomach

15

Post-op what CV complication should you be weary of in a DM patient?

"Silent" MI

16

What are the consequences of fatty liver in terms of surgery?

1) Anesthetic drugs are metabolized by the liver
2) Hepatotoxic drugs can have an enhanced effect

17

What is Fournier's Gangrene?

- Gangrene of the genital region
- Seen in DM patients

18

How does Fournier's Gangrene present?

Pain/ fluid accumulation in the groin

*This is an emergent surgical referral

19

What medications can have an adverse effect on blood sugar in DM patients in the hospital?

1) Glucocorticoids
2) TPN